PE Auditor

PE Auditor Virtual Altamonte Springs, FL

AdventHealth Corporate

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Internal Employees Apply Here

• Job Schedule: Full-time
• Pay Range: $27.46 - $41.18
• Job ID: 24045004
• Job Family: Physician Services
• Shift: 1 - Day
  
  

Hospitals, medical centers and facilities need more than physicians, nurses and specialists delivering care to our patients. A truly successful health care organization needs a thoughtful, dedicated, steady and experienced team working behind the scenes to make sure communities around the country receive the health care they need.

If you’ve also been interested in working in the health care field but aren’t a health care provider, a corporate career at AdventHealth may just be the perfect fit. We’re a faith-based health care organization headquartered in Altamonte Springs, Florida. As a national leader in quality, safety and patient satisfaction, our 92,000 team members maintain a long tradition of whole-person health by caring for the physical, emotional and spiritual needs of every patient.

Start your journey with a health care career at AdventHealth Corporate.

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we’re committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

All the benefits and perks you need for you and your family:

• Benefits from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support
  
  

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Job Location: Monday-Friday 9:00am to 5:00pm Remote

The Role You’ll Contribute

The Auditor is responsible for reviewing medical record documentation making sure that the CPT, ICD-10 and HCPCS codes and modifiers are correct for the selected claims. The Auditor will follow AH policies and procedures for annual audit schedules for both physicians and practices. The Auditor is responsible for completing professional reports of their findings and delivering those results to physicians and leadership.

The Value You’ll Bring To The Team

• Utilizing Expert auditing knowledge, interprets and reviews medical record documentation to make sure the accurate ICD-10, CPT, HCPCS and modifiers are assigned based on provider documentation.
• Expertise in auditing using both the 1995 and 1997, and 2021 E/M CMS Guidelines
• Provides education to providers, practice staff, and coders as needed based on audit results, coding updates and documentation needs.
• Demonstrates knowledge of sequencing diagnoses and procedures as outlined in the Official Coding Guidelines, CPT, HCPCS Level II and CMS guidelines.
• Demonstrate expert job knowledge and applies current coding and billing regulations, policies, processes, and procedures with effective decision-making and problem-solving skills.
• Maintains an accuracy rate of 90% or above for all work Quality Assurance reviews.
• Complete assigned work in a timely manner and maintain departmental production standards.
• Critical thinking and problem-solving skills are essential along with the ability to work independently, remotely and with minimal supervision. Must be self-motivated and able to use electronic resources.
• Responsible for accurately interpreting and communicating Federal guidelines and educating based on CMS sources.
• Serves as an expert resource to coding managers and supervisors.
• Create, prepare, and present educational materials on a wide variety of coding and billing topics to be presented to the multiple departments to internal team, physicians, and leadership.
• Utilizes a high degree of coding knowledge based in multiple medical service lines as well as multiple specialties throughout the Organization.
• Review highly complex escalated surgical cases, to be reviewed with Corporate Responsibility, Legal and Physicians.
• Identify coding trends based on audit results and communicate with Coding Integrity Manager and Corporate Responsibility to determine appropriate next steps.
• Ability to connect effectively with practice leadership, Corporate Responsibility and Revenue Cycle to answer and assist on coding and documentation topics.
• Track and schedules audits based on escalation policies.
  
  

Qualifications

The expertise and experiences you’ll need to succeed:

Knowledge And Skills Required

• Expert knowledge of ICD-10, CPT, HCPCS, and coding, along with modifiers for outpatient and inpatient procedures.
• Expertise in auditing using both the 1995 and 1997, and 2021 E/M CMS Guidelines
• Extensive knowledge of NCCI, MU, MUE edits and bundling guidelines.
• Demonstrates excellent written and verbal communication skills.
• Knowledgeable with Microsoft Office software.
• Ability to effectively operate equipment such as PC, web and/or teleconference.
• Ability to educate providers and staff on required documentation needs, coding updates and audit findings.
  
  

Knowledge And Skills Preferred

• Expert knowledge of Evaluation & Management (E&M) rules and surgical coding.
• Ability to explain required documentation needs to physicians, staff, and coding staff via EMR system.
• Experience presenting to large groups of peers or physicians/providers and leadership.
  
  

Education And Experience Required

• High School Diploma or equivalent required.
• Five (5) or more years of experience in physician-based coding for both E&M (outpatient/inpatient) and surgical procedures.
• At least three (3) years of certified auditing experience.
  
  

Education And Experience Preferred

• Technical program certification in medical coding or associate degree in Medical Billing/Coding.
  
  

Licensure, Certification Or Registration Required

• Certified Professional Coder (CPC) or Certified Coding Specialist – Physician (CCS-P)
  
  

AND

• Certified Professional Medical Auditor (CPMA)
  
  

FACILITY SPECIFIC SECTION

• Upholds AdventHealth values
• Maintains confidentiality and demonstrates sensitivity in working with AH employees.
• Follows Share Principles
• Follows AdventHealth attendance guidelines
• Demonstrates knowledge of operational policies and procedures
• Performs all duties in accordance with AH policies and procedures
• Follows Employee Guidelines
• Performs other duties as assigned.
  
  

MUST HAVE

• CPC
• CPMA
• Physician Education Experience
  
  

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category: Physician Services

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 24045004

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

Apply Now

Apply Now

Internal Employees Apply Here

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Our Promise To You

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.